Provider Demographics
NPI:1275924094
Name:FABIAN, TARYN K (ATC)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:K
Last Name:FABIAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 OAKFIELD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-0829
Mailing Address - Country:US
Mailing Address - Phone:813-381-3852
Mailing Address - Fax:813-381-3873
Practice Address - Street 1:1532 OAKFIELD DR
Practice Address - Street 2:SUITE A
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-0829
Practice Address - Country:US
Practice Address - Phone:813-381-3852
Practice Address - Fax:813-381-3873
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 38682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer